Analyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, DET,CRT Medical necessity, Correct Coding Initiative, Outpatient Code Editor(OCE), Inpatient Code Editor,
Self Administered and other claims requiring clinical expertise's
Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record
Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership
Reviews all BHL, Mutual, FCSO, PAS Billing Compliance correspondence and adheres to all guidelines
Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems
Serves as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues
Member of facility FECC Committee; reports charging issues, etc.
Maintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls per Company Requirements
Perform other related functions as assigned
Qualifications: EDUCATION
High School diploma or GED required RN preferred EXPERIENCE Healthcare experience required, Clinical experience preferred
